Efficacy evaluation of anterior lesion resection combined with autologous bone grafting in the treatment of kyphotic deformity secondary to cervical tuberculosis

Tuberculosis of the lower cervical spine often results in vertebral destruction, kyphotic deformity, and neural compression, substantially impairing patients’ quality of life. Anterior surgical approaches allow direct access to the lesion, enabling thorough debridement and neural decompression. Autologous iliac crest bone grafting is regarded as the preferred material for spinal reconstruction. However, comprehensive evaluations of the systemic efficacy of this surgical modality in managing cervical tuberculosis complicated by kyphosis remain limited. A retrospective review was conducted on 49 patients diagnosed with lower cervical spinal tuberculosis presenting with kyphotic deformity, who were treated at the Affiliated Hospital of Ningxia Medical University from January 2007 to December 2023. All patients underwent a single-stage anterior debrided lesion resection combined with autologous iliac crest structural grafting and short-segment internal fixation, following at least two weeks of standardized anti-tuberculosis therapy preoperatively. Perioperative data—including operative duration and intraoperative blood loss—were recorded. Clinical and radiographic follow-up was maintained for no less than 12 months postoperatively, with assessments including visual analog scale (VAS) for pain, Frankel neurological grading, local Cobb angle, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and graft union status. The mean operative time was 120.8 ± 12.5 min, with intraoperative blood loss averaging 90.6 ± 12.2 mL. The mean follow-up duration was 18.23 ± 4.12 months. At final follow-up, the local Cobb angle improved from −3.87 ± 1.15° preoperatively to 4.63 ± 0.98° (mean correction of 8.50°, P < 0.05). Pain scores decreased significantly from 6.51 ± 1.00 to 1.41 ± 0.91 (P < 0.05). ESR and CRP levels demonstrated significant reductions (P < 0.05). Neurological function, as indicated by Frankel grading, markedly improved postoperatively. The graft fusion rate was 100%, with an average fusion time of 4.29 ± 1.06 months. Postoperative complications included transient hoarseness in 2 cases, iliac crest pain in 5 cases (all resolved at the final follow-up), and hepatic function impairment in 4 cases (resolved after medication adjustment). No cases of implant failure or tuberculosis recurrence were observed. Anterior debridement combined with autologous iliac crest bone grafting and internal fixation provides effective mid-term outcomes in the management of lower cervical tuberculosis with kyphotic deformity. This approach facilitates infection eradication, deformity correction, and restoration of cervical stability. However, surgeons should carefully consider the potential for donor site complications and recognize that surgical success highly depends on the surgeon’s experience. Future multicenter prospective studies are necessary to validate long-term efficacy and to explore novel bone graft substitutes that may optimize individualized treatment strategies.